Provider Demographics
NPI:1316241268
Name:NORMANDY OPTICAL WEST, PLLC
Entity type:Organization
Organization Name:NORMANDY OPTICAL WEST, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAZIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-978-7232
Mailing Address - Street 1:36838 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4455
Mailing Address - Country:US
Mailing Address - Phone:586-978-7232
Mailing Address - Fax:586-978-2745
Practice Address - Street 1:36838 RYAN RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4455
Practice Address - Country:US
Practice Address - Phone:586-978-7232
Practice Address - Fax:586-978-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty